Strongyloides Stercoralis Infection Among Human Immunodeficiency Virus (HIV)-Infected Patients in the United States of America: A Case Report and Review of Literature

BACKGROUND Strongyloides stercoralis infection is endemic in subtropical and tropical regions but is reported rather sporadically in temperate countries. In the USA, the highest rates of infection are from the southeastern states, predominantly among immigrants. There is paucity of case reports on S...

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Published in:	The American journal of case reports Vol. 18; pp. 339 - 346
Main Authors:	Vazquez Guillamet, Laia Jimena, Saul, Zane, Miljkovich, Goran, Vilchez, Gabriel Alejandro, Mendonca, Nikolai, Gourineni, Venkata, Lillo, Nicholas, Pinto, Marguerite, Baig, Aurengzaib, Gangcuangco, Louie Mar
Format:	Journal Article
Language:	English
Published:	United States International Scientific Literature, Inc 03-04-2017
Subjects:	AIDS-Related Opportunistic Infections - diagnosis Animals Diarrhea - parasitology HIV Infections - complications Humans Male Middle Aged Strongyloides stercoralis - isolation & purification Strongyloidiasis - diagnosis United States
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Summary:	BACKGROUND Strongyloides stercoralis infection is endemic in subtropical and tropical regions but is reported rather sporadically in temperate countries. In the USA, the highest rates of infection are from the southeastern states, predominantly among immigrants. There is paucity of case reports on S. stercoralis infection among HIV-infected patients who were born and raised in the USA. CASE REPORT A 61-year-old male with known HIV infection (CD4 count: 235 cells/uL, undetectable HIV RNA, on antiretroviral therapy) presented with a 3-month history of diarrhea. He was initially diagnosed to have diarrhea secondary to norovirus and later with Escherichia coli. He was treated with levofloxacin but the diarrhea persisted. Stool PCR, Clostridium difficile enzyme-linked immunoassay, cryptosporidium and giardia antigen, cyclospora and isospora smear, and fecal microscopy were all negative. Peripheral blood eosinophil count was 1,000 eosinophils/mcL. Colonic biopsies revealed fragments of S. stercoralis larvae within the crypts. The patient was treated with ivermectin with improvement of symptoms. Social history revealed that he was born and raised in the northeastern USA. He was a daily methamphetamine user and engaged in anal sex with men. He denied travel to endemic areas, except for a visit to Japan more than 30 years ago. CONCLUSIONS Our case highlights that S. stercoralis may be an underdiagnosed/under-reported cause of chronic diarrhea among HIV-infected patients. What makes this case peculiar is that the patient was born and raised in the continental USA, absence of recent travel to endemic areas, and relatively high CD4 counts. Parasitic infections, such as S. stercoralis, should be considered among HIV-infected patients with persistent diarrhea and eosinophilia regardless of ethnicity or recent travel history.
Bibliography:	ObjectType-Case Study-3 SourceType-Scholarly Journals-1 content type line 23 ObjectType-Review-1 ObjectType-Feature-5 ObjectType-Report-2 ObjectType-Article-4 Funds Collection Authors’ Contribution Conflict of interest: None declared Data Interpretation Literature Search Data Collection Study Design Manuscript Preparation Statistical Analysis
ISSN:	1941-5923 1941-5923
DOI:	10.12659/AJCR.902626